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“It Was Not My Aim to Sleep There”: The Impact of Timing and Location of Sex on Adherence to Coitally-Dependent HIV Pre-exposure Prophylaxis

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Abstract

The FACTS 001 trial found that vaginal pre- and post-coital application of 1% tenofovir gel did not prevent HIV-1 infection amongst young South African women. The trial included a multi-faceted approach to adherence support and collected objective and self-reported adherence measures. Using qualitative data collected from a random sub-set of FACTS 001 participants (135 in-depth interviews at product discontinuation and 13 focus group discussions at dissemination of trial results), we explore the importance of ‘place’ and ‘timing’ in shaping acts of sexual intimacy and product adherence. Demographically, this qualitative sub-sample is similar to the trial cohort of predominantly young, unemployed women living with parents or other family members. Sexual intimacy was largely unpredictable and happened across multiple locations in which women had limited privacy, autonomy, or control over the timing of sex. This made adherence to the dosing strategy challenging. Findings may inform the development of future event-driven pre-exposure prophylaxis regimens or products.

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Acknowledgements

This study was made possible by the generous support of the American people through the United States Agency for International Development (USAID) under a Sub-agreement (MAPS1-14-016) from a Cooperative Agreement (AID-OAA-A-14-00011) with CONRAD, Eastern Virginia Medical School. CONRAD also supported the study with funds from the Bill and Melinda Gates Foundation (Grant ID 41266). The views expressed by the authors do not necessarily reflect the views of USAID, the United States Government, the Gates Foundation, or Eastern Virginia Medical School. SDM, JS, FS and DB were supported in part by a grant from the UK Department for International Development to the STRIVE Research Programme Consortium (Ref: Po 5244). However, the views expressed do not necessarily reflect the Department’s official policies. The authors thank the South African Department of Science and Technology and the Department of Health for their support offered to the FACTS 001 trial.

Funding

This study was funded by the United States Agency for International Development (USAID) under a Sub-agreement (MAPS1-14-016) from a Cooperative Agreement (AID-OAA-A-14-00011) with CONRAD, Eastern Virginia Medical School; by the Bill and Melinda Gates Foundation (Grant ID 41266); and by a grant from the UK Department for International Development to the STRIVE Research Programme Consortium (Ref: Po 5244).

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Authors and Affiliations

  1. Wits RHI, Faculty of Health Sciences, University of the Witwatersrand, Corner Esselen and Klein Street, Hillbrow, Johannesburg, 2001, South Africa

    Fiona Scorgie, Jonathan Stadler, Deborah Baron, Thesla Palanee-Phillips, Helen Rees & Sinead Delany-Moretlwe

  2. CONRAD, 1911 North Fort Myer Drive, Arlington, VA, USA

    Susan Ju

  3. MEDUNSA Clinical Research Unit (MeCRU), Ga-Rankuwa, North West Province, South Africa

    Tshepiso Ikaneng

  4. MatCH Research Unit, Department of Obstetrics and Gynaecology, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa

    Zonke Mabude

  5. The Aurum Institute, Johannesburg, South Africa

    Sylvia Makgopa & Matshidiso A. Malefo

  6. Setshaba Research Centre (SRC), Soshanguve, Pretoria, South Africa

    Kgahlisho N. Manenzhe

  7. Qhakaza Mbokodo Research Centre, Ladysmith, South Africa

    Thulani Mazibuko

  8. The Desmond Tutu HIV Foundation, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa

    Hilda Ntjana

  9. Perinatal HIV Research Unit (PHRU), University of the Witwatersrand, Chris Hani Baragwanath Hospital, Soweto, South Africa

    Busi Nkala

  10. South African Medical Research Council, Cape Town, South Africa

    Glenda Gray

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  1. Fiona Scorgie
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  2. Jonathan Stadler
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  3. Deborah Baron
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  16. Sinead Delany-Moretlwe
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Correspondence to Fiona Scorgie.

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Conflict of interest

Fiona Scorgie declares that she has no conflict of interest. Jonathan Stadler declares that he has no conflict of interest. Deborah Baron declares that she has no conflict of interest. Susan Ju declares that she has no conflict of interest. Tshepiso Ikaneng declares that she has no conflict of interest. Zonke Mabude declares that she has no conflict of interest. Sylvia Makgopa declares that she has no conflict of interest. Matshidiso A. Malefo declares that she has no conflict of interest. Kgahlisho N. Manenzhe declares that she has no conflict of interest. Thulani Mazibuko declares that he has no conflict of interest. Hilda Ntjana declares that she has no conflict of interest. Busi Nkala declares that she has no conflict of interest. Thesla Palanee-Phillips declares that she has no conflict of interest. Glenda Gray declares that she has no conflict of interest. Helen Rees declares that she has no conflict of interest. Sinead Delany-Moretlwe declares that she has no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Scorgie, F., Stadler, J., Baron, D. et al. “It Was Not My Aim to Sleep There”: The Impact of Timing and Location of Sex on Adherence to Coitally-Dependent HIV Pre-exposure Prophylaxis. AIDS Behav 22, 3692–3704 (2018). https://doi.org/10.1007/s10461-018-2195-1

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